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Syncope and seizures are often indistinguishable clinically.We present a series of 12 patients diagnosed as having epilepsy.Despite normal or nonspecific electroencephalographic findings,11 of 12 patients were treated or offered treatment with long-term anticonvulsant agents. Subsequently,diagnoses of arrhythmic or neurally mediated syncope were made in all patients using Holter monitoring,long-term ambulatory loop electrocardiographic recording,or tilt-table studies.Arrhythmias included torsales de pointes(four patients),atrioventricular nodal reentrant supraventricular tachycardia(one patient),and sinus arrest(two patients). The remaining five patients had neurally mediated syncope with hypotension and bradycardia,including asystole in two patients.Treatment for the documented cardiovascular abnormalities resulted in the alleviation of syncopal symptoms.Because the observed cardiovascular abnormalities are potentially fatal,this series suggests that undiagnosed cardiac syncope may contribute to the documented increased sudden death rate in patients with presumed epilepsy.Cardiac causes of loss of consciousness should be considered in patients with presumed epilepsy,atypical premonitory symptoms(such as nausea,lightheadedness,or palpitations),nondiagnostic electroencephalograms,and failure to respond to anticonvulsant therapy. |
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arrhythmia,cardiac asystole cardiovascular disease convulsive syncope electrocardiogram,abnormal electrocardiogram,loop heart block heart block,complete Holter monitoring misdiagnosis pacemaker,cardiac-transvenous Romano-Ward syndrome seizure seizure,cardiac arrhythmia causing seizure,complications following seizure,differential diagnosis of seizure,medication failure sudden death syncope syncope,differential diagnosis of torsades de points treatment of neurologic disorder unconsciousness upright-tilt test vasovagal episode
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